An ectopic pregnancy, or eccyesis, is a complication of pregnancy in which the pregnancy implants outside the uterine cavity. With rare exceptions, ectopic pregnancies are not viable. Furthermore, they are dangerous for the mother, internal bleeding being a common complication.
Most ectopic pregnancies occur in the Fallopian tube (so-called tubal pregnancies), but implantation can also occur in the cervix, ovaries, and abdomen. An ectopic pregnancy is a potential medical emergency, and, if not treated properly, can lead to death.
In a normal pregnancy, the fertilized egg enters the uterus
and settles into the uterine lining where it has plenty of room to
divide and grow. About 1% of pregnancies are in an ectopic location
with implantation not occurring inside of the womb, and of these 98%
occur in the Fallopian tubes.
In other words it can be said that in an ectopic pregnancy
the embryonic implantation occurs outside the uterus,most commonly in
the fallopian tubes but at times also in the extra tubal locations. It
poses serious threat to the general andreproductive health of the
mother.
Ectopic pregnancy comprises 2% of all pregnancies reported
to the Centre for Disease Control and Prevention has been noted that
ectopic pregnancy is steadily and persistently rising since 1970.
Between 1970 and 1992, the rate of ectopic pregnancy
increased from 4.5 to 19.7 per 1000 reported pregnacies [includinglive
birth, legal abortions and ectopic pregnancies.
Detection of ectopic pregnancy in early gestation has been
achieved mainly due to enhanced diagnostic capability. Despite all
these notable successes in diagnostics and detection techniques ectopic
pregnancy remains a source ofserious maternal morbidity and mortality
all over the world.
In a typical ectopic pregnancy, the embryo does not reach
the uterus, but instead adheres to the lining of the Fallopian tube.
The implanted embryo burrows actively into the tubal lining. Most
commonly this invades vessels and will cause bleeding. This intratubal
bleeding (hematosalpinx) expels the implantation out of the tubal end
as a tubal abortion. Some women thinking they are having a miscarriage
are actually having a tubal abortion. There is no inflammation of the
tube in ectopic pregnancy. The pain is caused by prostaglandins
released at the implantation site, and by free blood in the peritoneal
cavity, which is a local irritant. Sometimes the bleeding might be
heavy enough to threaten the health or life of the woman. Usually this
degree of bleeding is due to delay in diagnosis, but sometimes,
especially if the implantation is in the proximal tube (just before it
enters the uterus), it may invade into the nearby Sampson artery,
causing heavy bleeding earlier than usual.
If left untreated, about half of ectopic pregnancies will
resolve without treatment. These are the tubal abortions. The advent of
methotrexate treatment for ectopic pregnancy has reduced the need for
surgery; however, surgical intervention is still required in cases
where the Fallopian tube has ruptured or is in danger of doing so. This
intervention may be laparoscopic or through a larger incision, known as
a laparotomy.
The most common complication is rupture with internal bleeding that
leads to shock. Death from rupture is rare in women who have access to
modern medical facilities. Infertility occurs in 10 - 15% of women who
have had an ectopic pregnancy.
Further Reading
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